Those eligible receive
single dose of antibiotics at pharmacy, without doctor visit
In the first program of its kind in the nation, local pharmacies
are offering eligible consumers on-site antibiotic treatment to reduce the
chance of developing Lyme disease.
The initiative is the result of collaborative practice
agreements among the University of Rhode Island College of Pharmacy, Green Line
Apothecary in South Kingstown, Seaside Pharmacy in Westerly and Dr.
Fredric Silverblatt, an infectious disease specialist with South County Health.
As part of the agreements, Anita Jacobson, clinical associate professor of pharmacy at URI and the program catalyst, trains pharmacists to provide the service, and Silverblatt acts as the clinical overseer.
In June, Green Line Apothecary, owned by pharmacist Christina
Procaccianti, became the nation’s first pharmacy to provide the single,
200-milligram dose of doxycycline on site without a doctor’s order.
“It’s been much more popular than I thought it would be,” said
Procaccianti, who administered about 20 doses in the first three weeks. “It’s
been very rewarding. If this can help prevent one case of Lyme disease, it’s
worth it.”
Prompt treatment with the antibiotic doxycycline is crucial to
successful treatment of the tick-borne illness, and making it readily available
without a doctor’s visit could help reduce the incidence of Lyme disease,
Jacobson said.
In fact, a 2001 study published in the New England Journal of Medicine reported that such prophylactic treatment can reduce the risk of developing Lyme Disease by 87 percent.
“Due to the time-sensitivity of treatment, community pharmacies
like Green Line and Seaside are ideal practice locations,” Jacobson said. “The
availability and convenience of a pharmacy are important to potentially
preventing development of Lyme disease.”
William Quirk, a URI pharmacy alumnus, will soon offer the
program at Seaside Pharmacy.
The service fits easily into Procaccianti’s practice. “It takes
about the same time as filling a prescription, and it is exciting for the
students (URI pharmacy interns) who get a chance to see a collaborative
practice agreement in a real-life setting,” she said.
The ease of pharmacy-based care is particularly beneficial to
tourists and others from out of town who might not get to their own doctor for
days or whose doctors might not recognize Lyme disease symptoms, Jacobson
noted. Procaccianti said she has treated several tourists who learned of the
service at local hotels.
Pharmacists assess the customers and determine whether they meet
U.S. Centers for Disease Control and Prevention criteria.
The antibiotic can be given only to patients who are at least 8
years old, have had a deer tick attached to the body for at least 36 hours and
have removed it no more than 72 hours prior. The protocol is only effective as
prophylaxis against Lyme disease, not other tick-borne illnesses.
Procaccianti said she has turned away customers who either did
not meet the criteria or removed insects that were not ticks. She said
education is an important part of the service, and to this end, she provides
interested customers with a detailed handout on tick-borne illnesses, treatment
and prevention.
Jacobson conceived the idea in 2012, and with pharmacy
colleagues Kelly Orr and Jeffrey Bratberg, conducted a research study to
determine the efficacy and practicality of offering the treatment in community
pharmacies. The study was a success: No subjects developed Lyme Disease after
receiving the treatment or developed serious adverse effects.
“The only way we could have pharmacists initiate antibiotic
therapy was for it to be a research study,” Jacobson said, explaining that the
practice required a research exemption from the Rhode Island Board of Pharmacy.
Jacobson then collaborated with the Rhode Island Pharmacists
Association and the Rhode Island Society of Health-System Pharmacists to pass
legislation in the state’s General Assembly in 2016 expanding pharmacists’ role
to include initiation of drug therapies under collaborative practice
agreements.
Any pharmacy in Rhode Island can participate once its
pharmacists receive training at URI and it is part of a collaborative practice
agreement with a doctor. To learn more, contact Anita Jacobson at anitaj@uri.edu.